MEDICARE: NJAH CLETUS NDI HHA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1467792531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NJAH CLETUS NDI HHA

Provider Business Mailing Address
First Line	:	7406 VANDENBERG CT
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3374
Country	:	US
Telephone Number	:	202-545-0935
Fax Number	:	202-545-0176

Provider Business Practice Location Address
First Line	:	7406 VANDENBERG CT
Second Line	:
City	:	LANHAM
State	:	MD
Zip	:	20706-3374
Country	:	US
Telephone Number	:	202-545-0935
Fax Number	:	202-545-0176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2013
Last Update Date	:	02/26/2013

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Directions to “ NJAH CLETUS NDI HHA” Practice Location

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